  | | 
03-09-2010, 07:52 AM
|
#1 (permalink)
| | Newbie
Join Date: Jan 2010 Location: Lafayette, IN
Posts: 5
Weight Statistics 02/08/2010 Start Date:
5' 1"
Height:
267 lb Start Weight:
245 lb Current Weight:
130 lb Goal Weight:
22 lb Weight Loss:
115 lb Lb Left to Lose:
8.23970037453 % % Lost:
Body Mass Index50.4436979307 BMI Start:
46.2872883633 BMI Current:
24.5606019887 BMI Goal:
|  BCBS with additional deductible for WLS?
I was wondering if anyone else has had this happen? My husbands company is switching insurance as of 4/1/10. We have Anthem now and are switching to BCBS PPO. I called the insurance company yesterday and they said that on top of our $500 deductible there is also a $3000 deductible for WLS!! I asked them to repeat it and asked if it was supposed to be Out-of pocket that they ment and they said no you have an additional deductible. I about passed out. I have a call into the Dr. to see if they have spoken to the insurance yet and to see if this is the case if they will make me pay that upfront before surgery. I dont have a date set yet but we were looking at end of April or beginning of May. 
__________________
 | 
|  |  | Weight Loss Surgery Insurance | | | |
|
| |
03-09-2010, 10:22 AM
|
#2 (permalink)
| | Seasoned Veteran
Join Date: Jan 2010 Location: Idaho
Posts: 3,952
Weight Statistics Jan 2009 Start Date:
Dec. 22, 2009 Surgery Date:
5' 6"
Height:
317 lb Start Weight:
194 lb Current Weight:
165 lb Goal Weight:
123 lb Weight Loss:
29 lb Lb Left to Lose:
38.8012618297 % % Lost:
May 2011 Goal Date:
Body Mass Index51.1595500459 BMI Start:
31.3089990817 BMI Current:
26.6287878788 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |
Its alot of money and sad that this happens , if we have all the criteria met for the surgery there shouldnt have to pay extra just becase we are FAT..this makes me so mad...I have to say i lucked out when I talked to our insurance company , we have a high deductable which I had met last year but when talking to them the man said you are one of the LUCKY ONES we pay 100 % ! then he went on to say most policies dont do this , I was surprised they could that , take our money all the time yet op to not pay 10% after we meet our deductable , just seems unfair...good luck hun , hope you dr workks with you on this..
__________________  | |
| | |
03-09-2010, 10:31 AM
|
#3 (permalink)
| | Guru In Training
Join Date: Jul 2009 Location: New Orleans, LA burbs
Posts: 202
Weight Statistics 01-01-09 Start Date:
August 17, 2009 Surgery Date:
5' 7"
Height:
257 lb Start Weight:
143 lb Current Weight:
145 lb Goal Weight:
114 lb Weight Loss:
-2 lb Lb Left to Lose:
44.3579766537 % % Lost:
Body Mass Index40.2474938739 BMI Start:
22.3945199376 BMI Current:
22.7077300067 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
I have Anthem as well, I know that all policys are different but I can only remember paying my maximum out of pocket because I did have an additional issue a week after my gastric bypass that required additional tests. I would check with the insurance person at your surgeons office, they seemed to give me a better picture of what I had to pay.
__________________  | |
| | |
03-09-2010, 02:21 PM
|
#4 (permalink)
| | WLS Master Guru
Join Date: May 2009 Location: Chicago, IL
Posts: 970
Weight Statistics June 15, 2009 Start Date:
June 15, 2009 Surgery Date:
5' 6"
Height:
285 lb Start Weight:
166 lb Current Weight:
140 lb Goal Weight:
119 lb Weight Loss:
26 lb Lb Left to Lose:
41.7543859649 % % Lost:
June 15, 2011 Goal Date:
Body Mass Index45.9951790634 BMI Start:
26.790174472 BMI Current:
22.5941230487 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
I work for the City of Chicago and have BCBS. I did not have any $3000 deductible - I know I would remember something like that. Get on the phone and check again just to be sure. (Is your Doc. and surgery facility within the network?) I know if either is outside the network there is much more out of pocket expense. That is way too much money.
| |
| | |
03-09-2010, 06:04 PM
|
#5 (permalink)
| | Seasoned Veteran
Join Date: Jan 2006 Location: Oklahoma City, Okla USA
Posts: 2,549
Weight Statistics 05/17/02 Start Date:
05/17/02 Surgery Date:
5' 5"
Height:
355 lb Start Weight:
190 lb Current Weight:
175 lb Goal Weight:
165 lb Weight Loss:
15 lb Lb Left to Lose:
46.4788732394 % % Lost:
Body Mass Index59.0686390533 BMI Start:
31.6142011834 BMI Current:
29.1183431953 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
definitely check make sure your facility you are trying to get the surgery you are at is not out of network for sure.
__________________ 
(Spring 2004)
(lowest body weight/size) --BREE
- Strength in body is fleeting, but MY strength is from the LORD whose strength never weakens...
--------------------- open RNY 5/17/2002 -166 lbs(-200 at lowest) 8 years post in May 2010
Open major abdominal surgery 4/6/2010 for internal hernia release, extensive scarring removal & Appendix removal
| |
| | |
03-09-2010, 06:23 PM
|
#6 (permalink)
| | Newbie
Join Date: Jan 2010 Location: Lafayette, IN
Posts: 5
Weight Statistics 02/08/2010 Start Date:
5' 1"
Height:
267 lb Start Weight:
245 lb Current Weight:
130 lb Goal Weight:
22 lb Weight Loss:
115 lb Lb Left to Lose:
8.23970037453 % % Lost:
Body Mass Index50.4436979307 BMI Start:
46.2872883633 BMI Current:
24.5606019887 BMI Goal:
|
I did check and double checks and we are in-network. I have my 2nd appt with the nutritionist and Dr tomorrow so hopefully I will find something out!! Thanks for your help
__________________
| |
| | |
03-09-2010, 06:30 PM
|
#7 (permalink)
| | Guru In Training
Join Date: Oct 2009 Location: Southern Oregon
Posts: 206
Weight Statistics April 30, 2010 Surgery Date:
5' 6"
Height:
274 lb Start Weight:
165 lb Current Weight:
145 lb Goal Weight:
109 lb Weight Loss:
20 lb Lb Left to Lose:
39.7810218978 % % Lost:
5/2011 Goal Date:
Body Mass Index44.2199265381 BMI Start:
26.6287878788 BMI Current:
23.4010560147 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
You are right, you can check again, but I have the same thing... Dang!! I knew ahead of time so I know I save now for May surgery. Apparently our employers can choose which package they sign up for, and ours chose the one with the bigger deductible for surgery. I just think that at least they pay most of it. My insurance also set up that they will have the whole $3000 payable to the hospital, so that I won't have to pay each provider small amounts. Also being the hospital if I need to make payments, I know they will take them. If I had had surgery last year I would not have had to pay this, but I KNOW it is worth it!!! Good luck to you, it looks like we will be having surgery the same time...
__________________ Catherine It's not whether you get knocked down; it's whether you get up. | |
| | |
03-09-2010, 06:53 PM
|
#8 (permalink)
| | Seasoned Veteran
Join Date: Jun 2007 Location: Tampa, FL
Posts: 3,605
Weight Statistics July 10, 2007 Surgery Date:
5' 6"
Height:
271 lb Start Weight:
175 lb Current Weight:
182 lb Goal Weight:
96 lb Weight Loss:
-7 lb Lb Left to Lose:
35.4243542435 % % Lost:
Body Mass Index43.7357667585 BMI Start:
28.2426538108 BMI Current:
29.3723599633 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
Two thoughts ~ try to have the surgery before that date and 2nd, keep in mind the cost of the surgery ~ I was in CCU for a couple of days and my bill was 75K ~ feel better about the 3K? Sorry, best I could do~~~ Most hospitals don't make you pay up front and most will do a payment plan.
__________________
 | |
| | |
03-10-2010, 07:38 PM
|
#9 (permalink)
| | Seasoned Veteran
Join Date: Jul 2009 Location: North
Posts: 2,180
Weight Statistics August 20, 2009 Surgery Date:
5' "
Height:
210 lb Start Weight:
102 lb Current Weight:
110 lb Goal Weight:
108 lb Weight Loss:
-8 lb Lb Left to Lose:
51.4285714286 % % Lost:
August 2010 Goal Date:
Body Mass Index41.0083333333 BMI Start:
19.9183333333 BMI Current:
21.4805555556 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
Clancy has a great idea. If at all possible have surgery before the change date. I have BCBS MESSA & it covered 100% of everything.
__________________  | |
| | |
03-11-2010, 08:28 AM
|
#10 (permalink)
| | Newbie
Join Date: Jan 2010 Location: Lafayette, IN
Posts: 5
Weight Statistics 02/08/2010 Start Date:
5' 1"
Height:
267 lb Start Weight:
245 lb Current Weight:
130 lb Goal Weight:
22 lb Weight Loss:
115 lb Lb Left to Lose:
8.23970037453 % % Lost:
Body Mass Index50.4436979307 BMI Start:
46.2872883633 BMI Current:
24.5606019887 BMI Goal:
|
Hi. Thanks for your response. It helps and yes the $3000 is better then paying it all and my life is worth more then $3000 so I will deal with it. One question for you. Were you in the process when your insurance changed? I just want to make sure they don't come up with some thing like you have been getting treated for this so it is pre-existing or something. I need to stop thinking of all the negative but I guess I am just trying to get myself prepared for anything they may throw at me. Thanks again!
__________________
| |
| | | Thread Tools | | | | Display Modes |  Linear Mode | 
Posting Rules
| You may not post new threads You may not post replies You may not post attachments You may not edit your posts
HTML code is Off
| | | | |
G.G.
